GLP-1 Receptor Agonists for Secondary Prevention After Myocardial Infarction and Stroke in Type 2 Diabetes: Nationwide Real-World Evidence

Jan 7, 2026European journal of preventive cardiology

GLP-1 Drugs and Their Role in Preventing Repeat Heart Attacks and Strokes in People with Type 2 Diabetes: Evidence from Across the Country

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Abstract

GLP-1 receptor agonist therapy was initiated in only ∼2% of myocardial infarction and stroke survivors with type 2 diabetes.

GLP-1 receptor agonists are linked to a lower risk of major adverse cardiovascular events (MACE) after myocardial infarction and ischemic stroke in patients with type 2 diabetes.
In a cohort of myocardial infarction survivors with type 2 diabetes, GLP-1RA use was associated with a 30% reduction in MACE risk.
GLP-1RA therapy also showed a 39% reduction in all-cause mortality and a 46% reduction in cardiovascular death among myocardial infarction patients.
Among stroke survivors with type 2 diabetes, GLP-1RA use was associated with a 29% reduction in MACE risk, a 41% reduction in all-cause mortality, and a 45% reduction in cardiovascular death.
Utilization of GLP-1RA therapy was particularly low among women and older adults, highlighting disparities in treatment access.

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AIMS: Glucagon-like peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular risk in patients with type 2 diabetes (T2D) and established atherosclerotic cardiovascular disease and are recommended in guidelines. We evaluated the real-world effectiveness of GLP-1RA therapy on cardiovascular outcomes in patients with T2D after myocardial infarction (MI) or ischemic stroke and examined trends and disparities.

METHODS: Using nationwide Czech registry data (2015-2024), we identified patients with incident nonfatal MI or ischemic stroke and confirmed T2D. GLP-1RA users-initiating therapy within 12 months post-event-were propensity score-matched to non-users. The primary outcome was major adverse cardiovascular events (MACE: nonfatal MI, nonfatal stroke, cardiovascular death); secondary outcomes included individual components and all-cause mortality.

RESULTS: GLP-1RA therapy was initiated in only ∼2% of MI and stroke survivors with T2D. Among 126,845 MI survivors, 28,206 had T2D; the matched cohort comprised 2,271 patients (401 GLP-1RA; median follow-up 35 months). GLP-1RA use was associated with lower risk of MACE (HR:0.7; 95%CI:0.52-0.93), all-cause (HR:0.61;95%CI:0.47-0.80) and cardiovascular death (HR:0.54, 95%CI:0.36-0.80). Among 177,115 stroke survivors, 73,750 had T2D; the matched cohort comprised 2,235 patients (385 GLP-1RA; median follow-up 27 months). GLP-1RA use was associated with lower risk of MACE (HR:0.71; 95%CI:0.54-0.94), all-cause (HR:0.59;95%CI:0.46-0.76) and cardiovascular death (HR:0.55; 95%CI:0.37-0.81).

CONCLUSIONS: GLP-1RA therapy after MI or stroke in T2D was associated with substantially lower risks of MACE, cardiovascular and all-cause death in real-world practice. Utilization remained low, particularly among women and older adults, underscoring the need for broader and more equitable implementation in secondary prevention.

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GLP-1 Receptor Agonists for Secondary Prevention After Myocardial Infarction and Stroke in Type 2 Diabetes: Nationwide Real-World Evidence

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